Bar coding in the Blood Bank

Transcription

1 Bar coding in the Blood Bank for Ease, Speed + Accuracy Ann Mountain Wilson, TSO MUHC ICCBBA-GS1 International Meeting June 20, 2008

2 Bar coding in the blood bank Bar coded Blood components Non bar coded Plasma derivatives Significant difference in: Efficiency Time to enter & verify entry Risk of error Reading, interpreting, data entry, data verification Costs associated Low efficiency, error management & correction Patient safety Aspect of data accuracy & traceability

3 McGill University Health Centre Specialties include: Auto/Allo Bone marrow/stem cell transplant Solid organ transplant IgHepB Hematology/oncology Cardiovascular surgery Obstetrics RhIG Neurology / Neurosurgery IVIg, Tisseel Apheresis Albumin Specialized Pediatrics / Neonatology Albumin Neonatal/pediatric cardiac surgery & ECMO Thalessemia & Sickle Cell Centre Hemophilia centre Factors

4 Stable (Fractionated) Products Entry activity per year Activity # entries # vials # vials/entry Received , Issued 17,154 50,698 3 Returns 2,847 5,830 2 Total activity 22, ,200 5

5 Product information entered: Blood components Order # Invoice # Date of receipt Supplier Product code & name Manufacturer Donor # Expiry date Collection date Blood group Phenotype Attributes (details Allogenic / Autologous / Directed Volume 13 Fields: 2 sources of info Invoice Actual product (bar codes) Plasma derivatives Order # Invoice # Date of receipt Supplier Product code & name Manufacturer Lot # Expiry date IU / vial (coagulation factors Sub-vial lot #s (Tisseel) 8 Fields: 2 4 sources Invoice Product code Actual product Manufacturers date sheet Tisseel subvial lot # sheet

6 Xx Bar codes confirmation of administration from paper document not the product itself

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8 No bar codes TIME Blood components Plasma derivatives Cost (22,500 vials/yr) Entry 13 sec / unit 60 sec / lot # 290 hrs / yr time (1 120 vials) = $7250 / yr

9 No bar codes Errors Product entry errors (reception / issuing etc.) Year Blood components Plasma derivatives Total April 2008 : TraceLine v9.4 (ISBT 128 compatible) Bar codes for attributes :CMV-, Irradiated, Directed Need to set defaults for product codes/attributes eliminated Bar codes Héma-Québec phenotype (needs verification)

10 Errors at the Blood Centre (HQ) Jan-June Similar lot # Wrong product delivered: IVIg 10g lot# 26N5KV1 et IVIg 5g lot# 26N5KW1 BayGam 2mL # 26N3WT1 et BayHepB 5mL # 26N53W1 Gammagard # VNE1A004 et Iveegam # VNE1A004A

11 Errors at the MUHC 2007 = 21 reported errors (18 of 21 database correction) 11 wrong lot numbers 5 wrong expiry dates 2 wrong product codes 1 wrong UI value for coagulation factor Jan-May 2008 = 7 errors 4 wrong lot numbers 3 wrong expiry dates **Includes reported events only. Errors corrected immediately are not be reported.

12 Database corrections Once moved, lab cannot modify data Database correction by supplier Cost : minimum $260 ($130 / hr x 2 hr (min) Risk of error during correction many vials affected at each status once moved Time to verify following correction. Temporary measures Quarantine until corrected Correct each issue voucher by hand to match vial (? s)

13 Database corrections 18 errors required database correction. Potential: 18 x $260 = $4680 per year Actual: 6 x $260 = $1560 per year Estimate ~36-40 errors requiring 15min to several hours to investigate and make appropriate correction. Estimate cost at $25/hour > $1000 per year Cost of frustration =???

14 Total cost Increased entry time = $7250 Supplier correction cost = $1560 Investigation & followup = $1000 Estimated cost ~ $10,000 / year

15 Errors impact on patient safety Expiry date (entered Dec 3) Nov 07: patient received expired Varizig exp, Mar 12 Traceability: Gammagard LE08G038AB vs LE08G038AD Dose: distributed 2 x *AB instead of 1 x *AB + 1 x *AD Detected by discrepancy in inventory following week Split the vials in system & entered portions into each potential recipient s file as possibly transfused in case of recall. IVIg 10g lot# 26N5KV1 et IVIg 5g lot# 26N5KW1

16 Date formats: mmm dd yyyy mmm-dd-yy mm yyyy yyyy mm dd m-d-yyyy d mmm aa mm/dd/yy dd mmm yyyy

17 Avoid long names Create product codes & names to fit most blood bank computer system windows.

18 Longer ISBT codes Shorten names to ensure pertinent info is legible in computer system windows.

19 Plasma derivatives to bar code: Product code & name limit length Manufacturer Lot numbers avoid O s & I s, & being too similar Tisseel sub-vial lot # on exterior packaging Expiry date standardize format IU per vial Get ready to enable bedside scanning To scan the actual product instead of voucher

20 Everyone makes mistakes.

21 Quality Assurance is about making it difficult to do it wrong and easy to do it right. Let s make it easy to do it right. by bar coding all products.